External Direct Current (DC) Shock

  1. CARDIOVERSION – Electrical termination of any arrhythmia other than ventricular fibrillation
  2. DEFIBRILATION – Electrical termination of one and only one arrhythmia: ventricular fibrillation


Cardioversion SVT ¼- ½  Joules/kg
VT 1-2 Joules/kg
Defibrillation VF 2-4 Joules/kg


  • Use the small paddle for children that will completely contact skin over their surface.
  • No dry contacts- Electrode pad or paste must completely cover the contact area between paddles and skin. Do not use ultrasound gel.
  • Never SYNC (synchronize) for ventricular fibrillation
  • Always SYNC for cardioversion, even for atrial “fibrillation”, whenever QRS is distinct
  • Connect 3 or 5 lead ECG cable for best SYNC during cardioversion
  • Power on
  • Set dose
  • Charge
  • Call “clear” and observe that all personnel are not in contact with the patient
  • Press hard for good contact (minimum paddle-to-skin electrical resistance)
  • Hold both buttons depressed for at least 3 seconds (sync takes time, particularly with relatively slow ventricular rates)
  • Always record rhythm strip during procedure (some machines do this automatically)

For subsequent cardioversion attempts, push SYNC again.

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